SPONTANEOUS DISSECTION OF THE INTERNAL CAROTID ARTERY

Abstract: Spontaneous dissection of the internal carotid artery has been considered a relatively rare cause of carotid artery occlusion. It is postulated this condition may not be uncommon and that some cases are not recognised.
The condition is characterised by typical clinical and radiological features which should suggest the diagnosis. Despite these suggestive features it appears that recognition of this condition is not widespread and the diagnosis may not be made.
Three cases of spontaneous dissection are reported. The clinical and radiological features will be emphasised and pathogenesis and treatment discussed.     

多普勒超声心动图无创估测闭塞性肺血管病肺动脉高压

本研究旨在探讨多普勒超声心动图无创估测闭塞性肺血管病肺动脉高压的价值。通过对19例闭塞性肺血管病患者进行多普勒超声检查,并与48小时内进行的右心导管检查资料做对比分析。结果提示,压差法能够直接准确测定肺动脉收缩压(SPAP),但仅限于存在三尖瓣反流的患者;血流加速度时间(ACT)、血流加速度时间/右室射血时间(ACT/RVET)和右室射血前期/血流加速度时间(RPEP/ACT)能够定量估测肺动脉高压,但明显受心脏指数(CI)的影响。     

心肌梗死并发脑梗死与颈动脉斑块相关性分析

目的通过对颈动脉内中膜厚度(IMT)的测定,探讨心肌梗死并发脑梗死与颈动脉斑块的相关性。方法采用彩色多普勒测定颈动脉IMT和硬化斑块指数及积分。检测155例患者,其中脑梗死组56例,心肌梗死组43例,心肌梗死并发脑梗死16例,同时检测40例无明显心脑血管疾病患者。结果 颈动脉IMT对照组明显低于其他3个观察组,P<0.01,而观察组的IMT明显高于正常P<0.01,但3个观察组间的IMT相比P>0.05;3个观察组间的颈动脉斑块检出率与对照组相比P<0.01,3个观察组中心肌梗死并发脑梗死组的检出率最高,但3组间比较P>0.05;3个观察组的斑块指数及斑块积分高于对照组P<0.01,心肌梗死并发脑梗死组高于心机梗死和脑梗死组,P<0.01,脑梗死与心肌梗死组相比P>0.05。结论 颈动脉斑块是反映动脉粥样硬化的较好指标,心肌梗死并发脑梗死时与斑块的栓出率、指数和积分成正比。     

日本血吸虫病快速筛检敏感询检指标探讨

目的 探讨快速筛检日本血吸虫病的敏感询榆指标。方法 在单因素分析的基础上，用Logistic回归分析法(后退法，Wald检验)筛选敏感询检指标，并进一步分析其筛检日本血吸虫病的效果。结果 单因素分析有5个指标与血吸虫病现症感染有明显联系，分别是过去1周腹痛史、过去1周脓血便史、既往血吸虫感染史、职业、年龄。经Logistic回归分析，只有过去1周腹痛史和职业两个指标进入模型，2指标单独筛检血吸虫病的特异度分别为91．9％(95％C．I．89．7％～94．1％)和38．3％(95％C．I．34．4％～42．2％)，灵敏度分别为32．5％(95％C．I．18．0％～47．0％)和87．5％(95％C．I．77．3％～97．7％)。综合筛选的灵敏度为92．5％(95％C．I．84．3％～100．0％)，特异度为36．8％(95％C．I．32．9％～40．7％)，ROC曲线下的面积为0．712(95％C．I．0．633～0．791)。结论 过去1周腹痛史和职业可以作为快速筛检日本血吸虫病的两个敏感询检指标。     

一种结合代谢的抗疟药体外筛选方法

目的 :建立一种结合肝微粒体代谢的抗疟药体外筛选方法。方法 :在恶性疟原虫体外培养筛选抗疟药的常规方法基础上 ,加入以大鼠肝微粒体及氧化型辅酶 等辅助因子组成的体外代谢系统 ,分别检测常用抗疟药氯喹、咯萘啶、环氯胍与氯胍的抗疟活性。结果 :除氯胍外 ,其它 3药的原药即有抗疟活性 ,但氯胍必须经代谢转化成代谢产物后才有抗疟作用。结论 :结合代谢的抗疟药体外筛选方法可以避免漏筛那些需经代谢转化后才具抗疟作用的化合物。     

脉冲多普勒超声心动图对冠心病舒张功能的研究

本研究应用脉冲多普勒超声心动图(PDE)技术,记录20例正常人和37例慢性冠心病伴充血性心力衰竭(CHF)患者的二尖瓣血流频谱。测值分析发现,冠心病伴CHF患者左室舒张早期充盈流速显著降低,晚期充盈流速补偿性升高,提示左室舒张功能障碍普遍存在。     

Extracranial internal carotid arterial disease in children with sickle cell anemia

Background

Sickle cell anemia is one of the commonest causes of stroke in children. It is usually, but not always, associated with intracranial vasculopathy. We have assessed the value of ultrasound screening for extracranial internal carotid artery disease.

Design and Methods

Using Doppler ultrasound scanning, we assessed peak systolic blood velocity, tortuosity and stenosis in the extracranial internal carotid arteries of 236 children with sickle cell anemia. Seventeen of the children had previously had a stroke. All measurements were performed as part of routine clinical care.

Results

The median extracranial internal carotid artery velocity was 148cm/s (5^th centile 84, 95^th centile 236). Higher velocities were significantly correlated with younger age, higher white blood cell counts and higher rates of hemolysis. Fourteen (5.9%) had tortuous extracranial internal carotid arteries and 13 (5.4%) had stenosis or occlusion. None of the children with tortuous vessels but 8 of those with stenosis had previously had a stroke; the presence of stenosis was strongly associated with overt clinical stroke (OR 35.9, 95% C.I. 9.77–132, P<0.001). In 6 children, extracranial stenosis was part of extensive intracranial vasculopathy, but in 2 there was no evidence of intracranial disease. Stenosis seemed to be more common in older children.

Conclusions

Extracranial internal carotid artery stenosis is strongly associated with stroke in children with sickle cell anemia, and may explain some cases of stroke without overt intracranial vasculopathy. Doppler ultrasound scanning of extracranial internal carotid arteries is non-invasive and fairly quick to perform and may identify children at increased risk of stroke who would otherwise be missed. The value of extracranial internal carotid artery scanning should be studied prospectively.     

大肠癌普查互补性筛检方案的研究

为减少序贯普查便隐血试验（ＦＯＢＴ）对大肠癌筛检的漏检率，我们联合采用人血红蛋白抗血清包被的含Ａ蛋白葡萄球菌（ＳＰＡ）进行免疫便隐血试验（ＳＰＡ试验）和直肠粘液Ｔ抗原检测（即Ｓｈａｍｓ试验）用于大肠癌普查初筛，以验证两者的互补效果。在７７４０例无症状人群中，阳性率ＳＰＡ试验为１１．１％Ｓ，ｈａｍｓ试验为８．９％共１４９８例阳性者行纤维结肠镜检查，检出大肠癌１１例，腺瘤８８例。其中ＳＰＡ试验中仅９例癌、５５例腺瘤呈阳性结果。Ｓｈａｍｓ试验中８例癌、５１例腺瘤阳性。由于癌肿有时对两种试验的阳性结果不重叠，因此结合两种试验可使癌检出率从单一初筛试验的８１．８％（ＳＰＡ试验）或７２．７％（Ｓｈａｍｓ试验）提高到９０．９％对腺瘤检出的互补作用则更为明显。本实验结果提示单纯以ＦＯＢＴ作为初筛指标进行序贯普查有一定局限性，利用对癌的检出具有不同机制和检出效果的初筛试验进行互补性普查，可减少大肠癌及癌前病变的漏检率。     

用重组 rK39抗原试纸条快速诊断内脏利什曼病

[目的 ]评价以恰氏利氏曼原虫类 kinesin基因中编码 39个氨基酸的基因片段 (r K39)为重组抗原 ,用于血清学诊断内脏利什曼病的价值。 [方法 ]在新疆喀什地区对 13例经脾检和骨髓穿刺阳性的内脏利什曼病患者 ,取一滴病人全血或血清滴在 r K39抗原试纸条底部的吸收垫上 ,血清中蛋白随缓冲液向试纸条上部移动 ,其中相应特异抗体可与 r K39抗原带结合 ,而产生阳性条带。同时 ,本文亦用相同阳性血清作了关于 r K 39抗原的 Western印迹分析对照。 [结果 ]EL ISA分析显示病人血清抗体滴度在 10 - 2～ 10 - 4 ,与所见到的 r K39试纸条上的反应强度符合。Western印迹分析亦显示阳性血清可识别 r K39蛋白条带。[结论 ]与传统诊断内脏利什曼病方法相比较 ,r K39试纸条更快速 ,特异 ,灵敏和低损伤性 ,可用于低发病率流行区的内脏利什曼病的诊断和筛选     

LONG‐TERM RESULTS OF GASTRIC CANCER SCREENING USING THE SERUM PEPSINOGEN TEST METHOD AMONG AN ASYMPTOMATIC MIDDLE‐AGED JAPANESE POPULATION

Background and Aim: In order to reduce gastric cancer death, mass screening for gastric cancer has been established in Japan for several decades. Only photofluorography is considered to be an acceptable screening method so far, but recent evidence may show the usefulness of serum pepsinogen (PG) measurement for gastric cancer screening. The aim of the present study was to elucidate the feasibility of measuring serum PG levels for detection of gastric cancers. Methods: Serum PG levels (PGI/PGII) were measured in asymptomatic middle‐aged Japanese between 1991 and 2005. Those with a PGI ≤ 70 ng/mL and PGI/PGII ≤ 3 were defined as having a positive PG test. According to the obtained results of serum PG levels and previous individual records, those with a positive PG test and those with a negative PG test took gastroendoscopy every 2 and 5 years, respectively. Results: The total number of participating individuals was 101 892 (mean age of 48.7 years). In a total of 21 178 planned gastroendoscopies (20.8%), 13 789 (65.1%) underwent gastroendoscopy and 125 gastric cancers were detected, which corresponded to 0.12% of all participants and to 0.91% of those with gastroendoscopy. Early‐stage cancers and intestinal‐type intramucosal cancers accounted for 80% and 39% of all the detected cancers, respectively. Conclusions: Serum PG measurement for mass screening of gastric cancer enabled us to achieve high recruitment for gastroendoscopy in intended individuals, a favorable detection rate of gastric cancer and, in particular, an extremely high proportion of early‐stage gastric cancer in all the detected cancers.     

COMMUNITY‐BASED MASS SCREENING FOR COLORECTAL CANCER BY A COMBINATION OF FECAL OCCULT BLOOD TESTING AND FLEXIBLE SIGMOIDOSCOPY

Background: There have only been a few large‐scale community‐based reports on the combination of immunological fecal occult blood testing (IFOBT) and flexible sigmoidoscopy (FS). Based on the results of mass screening at our hospital, we investigated the utility of combining IFOBT with FS to detect colorectal cancer (CRC) and analyzed the detection rates of CRC. Subjects and methods: The subjects comprised examinees during mass screening for CRC from 1992 to 2002. Only examinees that underwent the 2‐day IFOBT method were enrolled. During the 11 years, 117 644 subjects had negative 2‐day IFOBT and underwent FS. Cancers that were directly found by FS or by work‐up examinations with negative 2‐day IFOBT were designated as IFOBT‐FS‐detected cancers. Results: The detection rate of CRC was 0.16% (mucosal cancer, 0.13%; invasive cancer, 0.03%) by negative 2‐day IFOBT and FS. It was 0.27% (mucosal cancer, 0.22%; invasive cancer, 0.05%) in first‐time examinees. The detection rate was significantly higher in males than in females, and rates increased with age in both genders. Adverse events included eight cases of ischemic colitis that occurred after FS (incidence rate, 0.0068%). There were no cases of perforation, hemorrhage or infection after endoscopy. Conclusion: Although there are problems in introducing FS into mass screening for CRC, such as cost‐effectiveness, speed of examinations and lack of manpower, FS is expected to prevail because preparation is easier, and it is a shorter and safer procedure than colonoscopy. In particular, a combination of IFOBT with FS is effective and recommended in first‐time examinees and for individuals 50 years and older. Mass screening using the combination of IFOBT and FS provides limited benefit in those who are below 50 years of age.     

NONINASIVE INVESTIGATION FOR RENAL ARTERY STENOSIS: CONTRAST-ENHANCED MAGNETIC RESONANCE ANGIOGRAPHY AND COLOR DOPPLER SONOGRAPHY AS COMPARED TO DIGITAL SUBTRACTION ANGIOGRAPHY

Introduction: The question about the most appropriate non-invasive method for detecting a renal artery stenosis (RAS) when comparing contrast enhanced magnetic resonance angiography (MRA) and color Doppler sonography (CDS) is still under discussion. Therefore we conducted a prospective study in order to evaluate both methods as compared to digital subtraction angiography (DSA).

Patients/Methods: Thirtysix consecutive patients (53,9±13,7 years) with suspected RAS were investigated. MRA was performed using gadolinium for contrast enhancement. CDS was performed using a 2.5 and 3,5 MHz transducer. A peak systolic velocity (Vmax) >200 cm/sec within renal arteries and/or a side to side difference of the resistive index (RI) of >0,05 were used to discriminate stenosis. A diameter reduction of ≥60% by DSA was considered a stenosis relevant to the patient.

Results: Sixtyeight main renal arteries and 9 accessory vessels were detected by DSA. Twenty main and 3 accessory arteries were found to be stenosed ≥60%, while 4 main and 1 accessory artery presented with occlusion. MRA detected 70 renal vessels (65 main and 5 accessory arteries). Twentyone stenosed arteries and 4 occluded vessels were correctly diagnosed by MRA. With CDS 68 renal vessels (62 main and 6 accessory arteries) could be visualized out of which 21 stenoses were diagnosed because of increased Vmax and 6 stenoses were detected because of a side to side difference of RI. For main renal arteries sensitivities and specificities were 96% and 86% for MRA and 96% and 89% for CDS.

Conclusions: MRA and CDS are both comparable methods for detection of a renal artery stenosis ≥60%. Despite several limitations, CDS can at the moment still be favored as a screening method.     

老年颈内动脉闭塞的眼动脉侧支血流动力学作用

目的探讨老年颈内动脉闭塞的眼动脉侧支血流动力学作用。方法对110例经磁共振血管成像或数字减影血管造影证实的老年一侧颈内动脉闭塞患者(闭塞组),采用经颅多普勒超声技术检测Willis环和眼动脉的侧支循环通路。闭塞组又分为眼动脉侧支组(40例)和无眼动脉侧支组(70例)。另设80例无颅内及颈部动脉病变患者为对照组。结果病变侧大脑中动脉的多普勒信号搏动指数(评估流入压力和远端血管阻力的指标)眼动脉侧支组和无眼动脉侧支组之间无差异,但是Willis环侧支通路[前交通动脉和(或)后交通动脉]的存在对大脑中动脉的搏动指数有明显作用。病变侧颈总动脉阻力指数眼动脉侧支组明显低于无眼动脉侧支组。结论眼动脉侧支对颈内动脉闭塞远端动脉床的血管阻力作用有限,而Willis环侧支在脑灌注上起重要作用。     

Carotid Wallstent Versus Roadsaver Stent and Distal Versus Proximal Protection on Cerebral Microembolization During Carotid Artery Stenting

ObjectivesThe aim of this study was to randomly compare the double-layer Roadsaver stent (RS) (Terumo, Tokyo, Japan) with the single-layer Carotid Wallstent (CW) (Boston Scientific, Santa Clara, California) in association with either distal embolic protection with the FilterWire (FW) device (Boston Scientific) or proximal protection with the Mo.Ma Ultra device (Medtronic, Santa Rosa, California) in patients with lipid-rich carotid plaques.BackgroundThe role of both stent type and brain protection during carotid artery stenting (CAS) remains unsettled.MethodsA total of 104 consecutive patients with carotid artery stenosis were randomized to CAS with FW + RS (group 1, n = 27), FW + CW (group 2, n = 25), Mo.Ma + RS (group 3, n = 27), or Mo.Ma + CW (group 4, n = 25). The primary endpoint was the number of microembolic signals (MES) on transcranial Doppler among groups in the following CAS steps: 1 and 2) target vessel access; 3) lesion wiring; 4) pre-dilation; 5) stent crossing; 6) stent deployment; 7) stent dilation; and 8) device retrieval and deflation.ResultsNo significant differences in baseline characteristics were found among the 4 groups. Compared with the FW device, the Mo.Ma Ultra device significantly reduced mean MES count (p < 0.0001) during lesion crossing, stent crossing, stent deployment, and post-dilation. Compared with the CW, the RS significantly reduced MES count (p = 0.016) in steps 6 to 8, including spontaneous MES (29% of patients). The combination of Mo.Ma + RS performed significantly better than Mo.Ma + CW (p = 0.043). Clinical major adverse cardiac and cerebrovascular events occurred in 3 patients (p = 0.51). After CAS, peak systolic velocity significantly decreased in all patients. In-stent restenosis developed in 1 patient (0.98%) at 6-month follow-up. The RS was an independent predictor of external carotid artery patency over time.ConclusionsIn patients with high-risk, lipid-rich plaque undergoing CAS, Mo.Ma + RS led to the lowest microembolic signals count. (Role of the Type of Carotid Stent and Cerebral Protection on Cerebral Microembolization During Carotid Artery Stenting. A Randomized Study Comparing Carotid Wallstent vs Roadsaver® Stent and Distal vs Proximal Protection; NCT02915328)